The AMDA Foundation proposes to develop a Long Term Care Quality Improvement Partnership that will enhance the quality of care and quality of life for the 1.6 million older adults who reside in the nation's 16,800 nursing facilities. The specific aims of the Partnership during the next 4 years are to: 1. Create a national partnership of organizations involved in the quality of nursing home care that in turn will promote the formation of local partnerships 2. Develop implementation tool kits for AMDA's evidence-based clinical practice guidelines (CPG) that relate to publicly reported quality measures 3. Identify and train interdisciplinary educators and mentors in 5 states who will provide onsite implementation training for 10 nursing facilities (50 total) 4. Evaluate the impact of CPG implementation on processes and outcomes indicators in the 50 facilities 5. Describe a set of model approaches to CPG implementation based on facility size and staffing, facility location and ownership and facility case-mix and 6. Disseminate the model approaches for implementation along with refined tool kits in both online and print versions National partners include AMDA, AMDA Foundation, AMDA Foundation Research Network American Health Quality Association representing all QIOs, major national nursing home trade associations, and representatives from key national long term care professional associations. AMDA will build upon its already existing national and local relationships with most of these partners to promote culture change within the facilities that fosters a sustainable approach to implementing CPG guidelines. Partnering with the QIO community, AMDA will develop supporting material and approaches to implementation of 3 CPGs in Phase I and at least 3 additional CPGs in Phase II. In Phase II through partnership with the Foundation's Research Network (a practice-based research network of 200 medical directors in 32 states) and the state QIO associations, we will select 50 pilot nursing homes to (a) receive more intensive CPG implementation onsite training and (b) evaluate change in processes of care and outcomes as well as resource utilization. Throughout Phase I and II, we will use the QIOs and other partners to disseminate material and lessons learned to all nursing homes throughout the country.